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TRANSCRIPT
Psychological First Aid: Increasing Resiliency
During COVID-19
May 19, 2020
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Northwest Mental Health Technology Transfer Center
Our Role:
Provide training and technical assistance (TA) in evidence-based practices (EBP) to behavioral health
and primary care providers, and school and social service staff whose work has the potential to improve
behavioral health outcomes for individuals with or at risk of developing serious mental illness in SAMHSA’s
Region 10 (Alaska, Idaho, Oregon, and Washington).
Our Goals:• Ensure availability and delivery of free, publicly-available training and TA to Region 10 providers.
• Heighten awareness, knowledge, and skills of the workforce addressing the needs of individuals with mental illness.
• Accelerate adoption and implementation of mental health-related EBPs across Region 10.
• Foster alliances among culturally diverse mental health providers, policy makers, family members, and clients.
www.mhttcnetwork.org/northwest
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The image part with relationship ID rId2 was not found in the file.
The MHTTC uses affirming language to promote the promises of recovery by advancing evidence-based and
culturally informed practices.
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> Will be shared in the chat box near the end & also emailed
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▪ There will NOT be certificates or CEUs for this series.▪ Slides, recording of webinar & resources WILL be posted
after the session
After today’s sessionPlease complete the evaluation survey (LINK):
POLL #1:Tell us about your role
POLL #2:Tell us about your (usual)
work setting
Today's Presenters
• Michele Bedard-Gilligan, PhDAssociate Professor, University of WashingtonDepartment of Psychiatry and Behavioral Sciences
• Emily Dworkin, PhDActing Assistant Professor, University of WashingtonDepartment of Psychiatry and Behavioral Sciences
Psychological First Aid: Increasing Resiliency During COVID-19
May 19, 2020
Michele Bedard-Gilligan, Emily Dworkin, & Kristen LindgrenUW Department of Psychiatry & Behavioral SciencesTrauma Recovery Innovations
> Adapted from:– World Health Organization Psychological First Aid: Guide for
Field Workers and Psychological First Aid Adapted for the Ebola Outbreak
– National Child Traumatic Stress Network PFA Manual, 2nd edition
– Materials developed by Dr. Debra Kaysen, Stanford University> Thanks to:
– UW Department of Psychiatry and Behavioral Sciences– UW COVID-19 Mental Health Working Group – Faculty and staff at Northwest MHTTC – SAMHSA
ACKNOWLEDGMENTS
> WHY: The need for resilience training following a pandemic
> WHAT: The foundations of PFA, what it is and is not> WHEN: The timing of PFA delivery> WHO: Identifying those who are most likely to
benefit from PFA> HOW: Delivery of PFA, strategies and tips
TRAINING OBJECTIVES: WHY, WHAT, WHEN, WHO, & HOW OF PSYCHOLOGICAL FIRST
AID (PFA)
PFA: THE WHY
Resilience is the process of adapting well in the face of adversity or significant sources of stress
• Resilience is ordinary & common, not extraordinary.
• Being resilient does not mean the absence of difficulty or distress.
• Resilience is not a trait -- it can be learned and acquired.
http://www.apa.org/helpcenter/road-resilience.aspx
RESILIENCE ISN’T ONE SIZE FITS ALL
SITUATIONAL RISK FACTORS
General Risk Factor Pandemic Examples Of High-Risk Health Care Workers
Severity of Event Those working directly on COVID units, the ER, or ICUThose who have observed patients dieThose with possible exposure themselvesThose who develop active infections
Life Stress Those with loved ones who are ill or vulnerableThose with numerous competing demands (childcare, financial concerns)
Social Support Those with limited contact with supportive loved onesThose with partners who are limited in their ability to provide support due to their own life demandsThose with loved ones who are negatively judging response to pandemic
PRE-EXISTING RISK FACTORS
General Risk Factor Pandemic Examples Of High-Risk Health Care Workers
PreviousExperiences
Those who have past trauma exposure, especially those who continue to struggle from that exposure
Mental health problems
Those with prior or ongoing mental health problems (example: depression, anxiety, PTSD, substance use problems)
Maladaptivecoping strategies
Those with prior or ongoing maladaptive coping strategies (example: using alcohol or other substances to cope)
HOW MIGHT COVID-19 AFFECT THOSE MORE DIRECTLY EXPOSED?
• High workload and increased stress
• Possible loss of coworkers
• Anxiety about their coworkers, patients, and families
• Distress about decisions about prioritizing & allocating care to others or themselves
Kaysen, 2020
WHAT HAPPENS DURING THE ACUTE AND CHRONIC STRESS PHASES MATTERS FOR
WHO RECOVERS
PFA: THE WHAT
Psychological First Aid (PFA) is a humane, supportive response to someone suffering
Acute intervention to reduce initial distress caused by traumatic events
Evidence informed
Increase sense of safety, connection, calmness, and hope
Increase access to social, physical and emotional support
Increase self-efficacy
Kaysen, 2020
PFA differs from traditional treatment
■ PFA is not therapy
■ It will not look like your standard therapy setting or structure■ It will not be the time or place to offer interpretations, do exposure, or dig into past learning experiences
■ It is NOT psychological debriefing
Kaysen, 2020
Kaysen, 2020
General PFA guidelines
Operate within a framework of an organized response system (part of a team)
Maintain confidentiality
Respect their right to make their own well-informed decisions
Be culturally sensitive and aware
Remain within scope of your expertise, role, and training
Practice self-care and be aware of your own physical and emotional reactions
PFA provides a way to structure responses to acute crisis reactions
Used as a stand-alone intervention
Integrated into a larger treatment
plan
PFA CORE THEMES: Provide practical care and support, which does not intrude
PFA: THE WHEN
PFA CAN BE DELIVERED
During a mass disaster
In the immediate aftermath
PFA can serve as a framework for intervention sessions that occur during
the acute COVID crisis; it’s an approach to prioritizing and responding to needs in
times of crisis
PFA: THE WHO
PFA DOES NOT REQUIRE A MENTAL HEALTH SPECIALIST FOR DELIVERY AND CAN BE
HELPFUL TO RANGE OF INDIVIDUALS
ProvidersDo not need to have a mental health background
Do need to be trained in PFA
Do need to have met their own needs first
RecipientsDo need to express interest in support and/or stabilization
Are often those at higher risk for developing negative outcomes due to proximity to crisis and/or other risk factors
There may be situations when someone needs more advanced mental health support
Know your limits
Know when and where to refer
Kaysen, 2020
PFA: THE HOW
Not necessarily sequential
Flexible
Based on the person’s specific needs and concerns
PFA is comprised of 8 core actions that are:
Kaysen, 2020
PFA has 8 core actions:
1. Contact and engagement
2. Safety and comfort
3. Stabilization
4. Information gathering
5. Practical assistance
6. Links to Social Supports
7. Information on coping
8. Links to services
Kaysen, 2020
PFA CORE ACTIONS: 1. CONTACT & ENGAGEMENT
2. SUPPORT SAFETY AND COMFORT
GOALS:– Build rapport– Support and enhance emotional and physical
safety– COVID-19 context
• Concerns about safety and wellbeing of self, loved ones, patients, & coworkers
PRO-TIP: ATTENDING TO BASIC NEEDS
SAFETY & COMFORT
Food
Shelter
Medical needs
YOU do not have to meet these needs
Problem-solvingMobilizing resources
Providing options
PFA: Good Communication in Crisis
Be calm and show understanding to help individuals in distress feel more safe and secure, understood, respected and cared for appropriately
Focus on what they want to tell you and how you can be of help
Allow some silence to give the person space and encourage them to share with you if they wish
Use simple, concrete terms without jargon
Acknowledge what they have done already to take care of themselves and others
Kaysen, 2020
Sit with emotionsProvide a safe place for individual to experience emotions
Let them tell you what they feel and need
Remain calm, control your own emotions, and don’t rush things
Remember: You can’t take away their pain and you don’t need to
PRO-TIP: RESPONDING TO STRONG EMOTIONS
Adapted from Kaysen, 2020
PRO-TIP: RESPONDING TO STRONG EMOTIONS
Validate emotionsRemind them there is no single or correct way to feel
Acknowledge they will probably continue to feel a range of up and down emotions for a while
Expect widely varying reactions to a crisis and do not judge
Help support parents and caregivers about how to talk to their children about the crisis
Adapted from Kaysen, 2020
PRO-TIP: RESPONDING TO ACUTE GRIEF DURING COVID-19
Typical grief processes, rituals, and supports are interrupted
Acknowledge potential departures from• Cultural, religious, and/or spiritual rituals• One’s own or loved one’s wishes
Help them identify• Achievable rituals• Ways to engage virtual supports and comfort
Adapted from Kaysen, 2020
• Not all individuals will need stabilization• Pay attention to
individuals whose reactions are so intense and persistent that it is impacting their ability to function
Goal:
To calm and orient
emotionally
overwhelmed/
disoriented survivors
Kaysen, 2020
PFA CORE ACTION 3. Stabilization
PRO-TIP FOR STABILIZATION: WHEN TO USE GROUNDING
PRO-TIP FOR STABILIZATION: HOW TO USE GROUNDING
PRO-TIPS
• PFA is not one-size fits all• Use active listening skills• Prioritization should be collaborative
• Know what resources are available and/or know how to find out
Goals:
1) Identify immediate needs & concerns,
gather information, & prioritize
2) Clarify needs & develop action plan
PFA CORE ACTIONS: 4. Information Gathering5. Practical Assistance
PRO-TIP: PROBLEM SOLVING FOR MAKING A PLAN
• Help establish brief or ongoing contacts with primary support persons and other sources of support
• family• friends• community
Goal:
Links to Social
Supports
Kaysen, 2020
PFA CORE ACTION: 6. Connection with Social Supports
PRO-TIP: SOCIAL SUPPORT HAS MANY FORMS
Support for needs
Emotional support
Social connection
Feeling needed
Reassurance of self-worth
Reliable support
Advice and information
Physical assistance
Material assistance
Kaysen, 2020
Provide information about
• stress reactions
• practical ways to cope, reduce
stress, and promote adaptive
functioning
Goals:
Kaysen, 2020
PFA CORE ACTION 7. Coping
REMEMBER: Any information you provide and skills you introduce or teach will be tailored to the individual’s concerns and priorities
PRO-TIP: Common Stress Reactions
Kaysen, 2020
Intrusive Reactions• Ways the event comes back to mind
Avoidance• Attempts to remove themselves from or protect themselves from
distress
Physical arousal & reactions• The body reacts as if danger is still present
• Rapid heartbeat, hyperventilation, headaches, dizziness, muscle aches,
Grief• Response to death of loved ones
Depressive Symptoms• Sleep problems, fatigue, worthlessness/guilt, suicidality
Exhaustion
Detachment
Anxiety
Irritability Insomnia
Reactions to Quarantine
Low mood
Poor concentration, indecisiveness
Reluctance to work
Kaysen, 2020
continue more than 2
months
It may be time to get more help if they:
worsen and impair
functioning
Kaysen, 2020
PRO-TIP: Normalize & Develop a Plan for Common Stress Reactions
• These reactions are natural, expected, andcommon
• Develop a plan to manage reminders of traumatic events, losses, & life changes
Talking to othersPositive
distracting activities
Resting and eating healthy
meals
Keeping a normal schedule
Taking regular breaks Using humor Scheduling
pleasant activities
Focusing on something
practical you can do right now
Using relaxation methods
Engaging in support
groups/counselingExercising Journaling
Kaysen, 2020
PRO-TIP: Identify existing coping strategies and potential new coping strategies
In teaching good nutrition we ask people to pick a balance of foods from different groups.
Do the same thing in terms of activities.
DEVELOPING A COPING PLAN
Think about roles and
values.
What’s on your plate?
• Work?• Health?• Family?• Friends?• Religion/spirituality?• Community service?• Hobbies?
DEVELOP A COPING PLAN
a regular sleep schedule and limit daytime napsEstablish
alcoholReduce
afternoon/evening caffeineEliminate
regular exerciseIncrease
relaxation before bedtime by doing something calmingCultivate
Kaysen, 2020
PRO-TIP: Addressing Sleep
Discuss ● their goals for use● difficulties in changing use
Ask them about the positives and negatives of using substances to cope
● Together, identify alternatives for use
Refer for treatment● if appropriate and desired by them
Kaysen, 2020
PRO-TIP: Addressing Problematic Substance Use
Guilt
Shame
Blame
Adapted from Kaysen, 2020
PRO-TIP: Addressing Unhelpful Thoughts
Gentle, curious questions can help address unhelpful thoughts and the strong emotions linked to them:• What would your
kindest self say about this?
• What are other ways to look at this situation?
Key Action:• to additional resources or services to address
current needs as neededConnect
• what is available• how to connect them to services (or who to ask)Know
• to identify what they needCollaborate
• to follow up and check-inOffer
Adapted from Kaysen, 2020
PFA CORE ACTION 8. Link with other services
PFA is a Framework for Building Resilience: Apply as Self-Care
General Resources & References
UW Specific Resources
Detailed PFA training
https://learn.nctsn.org/course/index.php?categoryid=11
PFA skills training manual
https://www.ptsd.va.gov/professional/treat/type/SPR/SPR_Manual.pdf
The PFA Mobile App
https://mobile.va.gov/app/pfa-mobile
PTSD Coach
https://www.ptsd.va.gov/apps/ptsdcoachonline/default.html
https://mobile.va.gov/app/ptsd-coach
Psychiatry Dept Website
https://psychiatry.uw.edu/clinical-care-consultation/covid-19-resources-for-mental-well-being/
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QUESTIONS & DISCUSSION
Your Feedback is Important:
• Please complete the anonymous evaluation by following the link in the chat box & you’ll get a reminder email also.
• Evaluation data is necessary for continued funding to offer programs
Post-event surveys are critical to our work!
Your feedback helps us to improve and develop future programing.
We greatly appreciate your feedback!
Get in TouchVisit us online:www.mhttcnetwork.org/northwest
Find out about:• Upcoming trainings
• New online trainings
• Resources and Research Updates
Email us:northwest@mhttcnetwork.org
Follow us on social media:@NorthwestMHTTC
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